In one study about 17% of patients undergoing renal denervation failed to achieve the anticipated drop in blood pressure, said Christian Ukena, MD, assistant professor of medicine at University Hospital, Saarland, Germany during a renal denervation session at the Transcatheter Cardiovascular Therapeutics meeting here.

But when response to treatment is measured by a reduction in heart rate of three beats per minute or more only 7% of patients would not receive benefit from the procedure, Ukena said.

Among patients whose heart rate was 71 beats per minute or greater at baseline, catheter-directed radiofrequency ablation reduced heart rate by 8.5 beats per minute at both 3-month (P<0.0001) and at the 6-month assessment (P=0.002), he said.

Among patients who had lower baseline heart rates, the effect on heart rate reduction was muted in the group with a heart rate of 61 beats per minute to 70 beats per minute but was still significantly lower than baseline – 3.1 beats per minute at 3 months (P=0.008) and 2.5 beats per minute at 6 months (P=0.035). Among those with heart rate less than 60 beats per minute at baseline heart rate increased modestly – 2.7 beats per minute at 3 months (P=0.035) and 2.5 beats per minute at 6 months (P=0.113).

"Renal denervation reduces central sympathetic activity," Ukena said in his oral presentation before a packed lecture room – far too small to handle the overflow crowd of interested practitioners.

In his trial, 127 patients concluded 3 months of treatment follow-up and 88 patients completed 6 months of follow-up. All the patients had refractory hypertension despite being prescribed at least three antihypertensives.

Most of the patients -- 83% -- achieved an overall reduction of 28.1 mmHg in systolic blood pressure (P<0.0001) from a baseline of 176.7 mmHg, but adding the heart rate endpoint boosted the response rate to 93%.

The average age of the participants was 62 years, and 58% of the patients enrolled in the study were men. They were on an average of 5.5 antihypertensives.

"The data presented by Dr. Ukena can be trusted," said Thomas Zeller, MD, chief physician at the Heart Center Bad Krozingen, Germany, and associate professor of medicine at Albert-Ludwigs-University Freiburg, Germany.

Zeller, the co-moderator of the TCT session, told MedPage Today, "It has been shown by other groups that following renal denervation heart rate drops."

Noting questions from the audience regarding increases in heart rate in the lowest heart rate group at baseline, Zeller suggested the phenomenon might be more to do with the patients' improvement due to blood pressure control than the treatment itself.

"This increase could simply be the consequence that in patients with improved blood pressure control following renal denervation therapy, beta-blockers are stopped as the first antihypertensive drugs," Zeller said.

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